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Gross anatomic relationship between the human left atrial appendage and the left ventricular summit region: implications for catheter ablation of ventricular arrhythmias originating from the left ventricular summit

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Abstract

Purpose

The left ventricular summit (LVS) is a source of difficult-to-treat arrhythmias because of anatomical limitations. The aim of this study was to perform detailed research of the left atrial appendage (LAA) anatomy of cadaveric hearts to analyze their complex anatomy and coverage of the LVS.

Methods and results

Eighty human formalin fixed hearts (mean age 44.4 ± 15.5, 27.5% females) were investigated. Each LAA size, type, and its relationship to the LVS were analyzed, as well as possible access sites for mapping/ablating electrode. Four types of LAA were observed over two LVS sites that are either accessible or not. The highest coverage over an inaccessible LVS area was observed in the Broccoli type, followed by the Windsock then the Chicken Wing and finally the Cactus types; over the accessible area of the LVS was observed in the Windsock, then in the Chicken Wing, then in the Cactus, and finally in the Broccoli types. The attainable coverage for electrode access is diminished from 25 to 65% because of the complex pectinate muscles and sharp angles. The highest density of the LAA floor made by pectinate muscles can be found in the Broccoli type (p < 0.005), while the Chicken Wing had the highest number of paper-thin-like pouches.

Conclusions

The LAA appears to be a promising entry for ablation-qualified patients with the LV summit originate arrhythmias. The complex internal structure of the LAA may complicate ablation procedures. More prominent appendages are promising in more extensive mapping areas over the LVS.

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Abbreviations

BMI:

Body mass index

BSA:

Body surface area

Cx:

Circumflex branch

Dg:

Diagonal branch

EAT:

Epicardial adipose tissue

GCV:

Great cardiac vein

LA:

Left atrium

LAA:

Left atrial appendage

LAD:

Left anterior descending artery

LCA:

Left coronary artery

LV:

Left ventricle

LVS:

Left ventricular summit

OM:

Obtuse marginal branch

PT:

Pulmonary trunk

RFCA:

Radiofrequency catheter ablation

SP:

Septal perforator

VA:

Ventricular arrhythmia

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Authors and Affiliations

  1. Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Cracow, Poland

    M. Kuniewicz, K. Budnicka, M. Dusza, N. Jakob, N. Cholewa, R. Defonseka, M. Gosnell, T. Wadhwa, J. Walocha, H. Dobrzynski & M. Hołda

  2. Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland

    M. Kuniewicz

  3. Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK

    H. Dobrzynski & M. Hołda

  4. HEART–Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland

    M. Hołda

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Contributions

M.K.: concept and design, anatomical dissections, photography, data collection, writing manuscript. B.K., D.M., J.N., C.N., D.R., G.M., W.T.: anatomical dissections, photography, data collection, English language support. H.D.: revising article critically for important intellectual content, English language support. M.H.: providing important intellectual content. J.W.: revising article critically for important intellectual content, final approval of submitted version. All authors have approved the final article.

Corresponding author

Correspondence to M. Kuniewicz.

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Ethics approval

This study was conducted at the Department of Anatomy of the Jagiellonian University Medical College and was approved by the Bioethical Committee of the Jagiellonian University in Cracow, Poland (1072.6120.131.2018). The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki. The methods were carried out in accordance with the approved guidelines.

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The authors declare no competing interests.

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Kuniewicz, M., Budnicka, K., Dusza, M. et al. Gross anatomic relationship between the human left atrial appendage and the left ventricular summit region: implications for catheter ablation of ventricular arrhythmias originating from the left ventricular summit. J Interv Card Electrophysiol 66, 301–310 (2023). https://doi.org/10.1007/s10840-022-01172-6

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